12 days of ER

In honour of finishing 12 days straight on ED....

~I present ~

12 Days of Christmas in ER

(originally from Life in the Fast Lane, December 19, 2012. Posted by Mike Cadogan, written by by Emily Adams and Susan Meegan)

 

On the first day of Christmas, my true love sent to me: A tubed patient looking at me!
On the second day of Christmas my true love sent to me: Two Full arrests And a tubed patient looking at me!
On the third day of Christmas, my true love sent to me: Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the fourth day of Christmas, my true love sent to me: Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the fifth day of Christmas, my true love sent to me: Five Eee/Nnn/Tee’s, Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the sixth day of Christmas, my true love sent to me: Six Drunks a swaying, Five Eee/Nnn/Tee’s, Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the seventh day of Christmas, my true love sent to me: Seven Psychs a waiting, Six Drunks a swaying, Five Eee/Nnn/Tss, Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the eigth day of Christmas, my true love sent to me: Eight Lacs a spurting, Seven Psychs a waiting, Six Drunks a swaying, Five Eee/Nnn/Tee’s, Four bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the ninth day of Christmas, my true love sent to me: Nine OD’s fitting, Eight Lacs a spurting, Seven Psychs a waiting, Six Drunks a swaying, Five Eee/Nnn/Tee’s, Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the tenth day of Christmas, my true love sent to me: Ten strokes a coning, Nine OD’s fitting, Eight Lacs a spurting, Seven Psychs a waiting, Six Drunks a swaying, Five Eee/Nnn/Tee’s, Four Bairatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the eleventh day of Christmas, my true love sent to me: Eleven Constipations, Ten strokes a coning, Nine OD’s fitting, Eight Lacs a spurting, Seven Psychs a waiting, Six Drunks a swaying, Five Eee/Nnn/Tee’s, Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!
On the twelfth day of Christmas, my true love sent to me: Twelve over census patients, Eleven Constipations, Ten strokes a coning, Nine OD’s fitting, Eight Lacs a spurting, Seven Psychs a waiting, Six Drunks a swaying, Five Eee/Nnn/Tee’s, Four Bariatric’s, Three Ramped patients, Two Full arrests, And a tubed patient looking at me!

I haven't written recently. But then again, neither has Shakespeare...

I realized today that the last post I (Barb) put up was in October, and so much stuff has happened!

After coming back from Canada in July, I was posted to do a Rural term in Bowen, QLD. That's 2.5 hr drive north of Mackay, or 12.5 hr drive north of Brisbane.  It's famous for mangoes, being a WW2 airforce base, and being the set of the movie "Australia".  Rob had to stay home and mind his job and the cats. It was lonely, but also good experience- The hospital was small enough that I had duties in both the ward and emergency.  And small enough that I was a needed pair of hands and gained all sorts of experience.

 One thing that was pretty neat was that the kitchen served meals flavoured with herbs grown right outside the kitchen door!

 Another regular occurrence was emergency air-lifting patients to a bigger centre, such as Mackay to the South, or Townsville, to the North. The helipad was about 25m from my bedroom, and the odd time gave me a heart attack as it was landing at 2 in the morning.

Rob came up and I went back down to Mackay as often as possible.
Then I moved on to one of the toughest rotations in intern year: Surgery. And it WAS tough. But I was lucky enough to be part of a great junior doctor team, and we managed to get through together.

Another story that has been evolving since April is my attempt to get onto ACRRM (Australian College of Rural and Remote Medicine) training for next year. Not having overcome some of my student tendencies, I put off my application until the last week. THEN I found out that as a sponsored work visa holder, I needed letters of support from every training provider (there are 19) that I wished to apply for. A scramble of emails later (I like to think of that as the collective noun for emails), I had managed to obtain only one, from QRME (Queensland Rural Medical Education). Fortunately, this was the group I was hoping to work with anyway.  I then needed to do the exams set out by AGPT, which involved situational judgement tests and multiple mini exam stations, times 8. The closest set were being held in Townsville, but would commence 2 days after I had left the country for Canada.  So I ended up in Toowoomba. This was great, as I got to see some Brisbane friends and stay with my good friend Anna while there.  Exams were done....flight to Edmonton undertaken. While in Edmonton, I got an email from AGPT asking for more paperwork, which was still in Mackay... and a transcript from UQ. This is where things got troublesome. UQ normally has an online request format for transcripts. However the server was down, and they were not accepting calls or emails with requests. By the time they repaired the problem and responded, they missed my needed deadline....and so my application was scrapped, and I needed to begin again the following April, from scratch, including repeating the exams.  I was "very put out."  THEN I got an email from AGPT that they were opening up second round offers. My transcript had limped in by this point, so I was eligible to try again. Gladly!  I had a Skype interview which started off with "We thought you'd be in the first round of offers??!!" So I was pretty confident I might get a spot. And in a few days received my acceptance!! So thrilled that God turned this set of events into something good!  I still have one hospital based year to complete to get all the ACRRM prerequisites, and Mackay Base Hospital has renewed my contract for the coming year.  So there is comfort in knowing where we will be for at least one more year.

Now I am based at Proserpine Hospital, fulfilling my Emergency Medicine term. It's interesting and broad based, with good support and consultants who are eager to teach. I also have 2 medical students following me around, so the cycle continues....

Christmas decorating

So Christmas is now less than a month away.  Christmas music is beginning to be played in the shops and the decorations are coming out. It amuses me that Australians try to do the Winter Wonderland when it is 30°C outside.  They do also have more 'native' Christmas decorations with Kookaburras and Eucalyptus leaves.

 

 

Thanksgiving in Australia, Take 5

Hard to believe, but this will be my 5th (Rob's 4th) Canadian Thanksgiving in Australia.  Turkey has become somewhat more common in QLD since my first attempt to put on a dinner. The first turkey had to be ordered 6 weeks in advance, and cost $75.00 for a 15 lb bird.  This year's turkey will be about $35.00 for the same, ordered a week in advance. Some of the other things that can't be had in Oz: Cranberry sauce or fresh/frozen cranberries are scarce, except around Christmas. And canned pumpkin cannot be gotten at all, except for ocanada.com.au, at $12.50 per can. But the Thanksgiving show must go on! So I've learned a few tricks over the years:

  I have found a recipe for making it from dried cranberries which is awesome, courtesy of chowhound:


dried cranberry sauce for thanksgiving:
1 1/2 cups dried craisins
3/4 cup water or preferably cranberry juice or pomegranate cran mix
1/3 cup sugar
dried orange peel, real, orange
1/4 tsp salt
peel, orange marmalade, or orange juice instead of water
add all ingredients and boil lightly until the cranberries plump up. then add 2 tbl of cornstarch to 4 tbl of water and add it slowly while at a slow simmer till it is thick and of the right consistency.

My family's pumpkin pie recipe is amazing, and I have tweaked it to work with a pumpkin that has to be cut, peeled, boiled and mashed:

 Pumpkin Pie

Cut up and peel and cube a pumpkin or part thereof. Boil or steam until soft. Mash or run through a food processor.
Now, for every 2 cups of mashed pumpkin, add:

3/4 cup sugar
1-2 tsp cinnamon
1 tsp dried ginger, nutmeg and allspice
1/2 tsp salt
a whiff of cloves and chili powder (optional)

Mix this into the pumpkin.
At this point, you can freeze the filling.




Or you can keep going and add:
2 eggs
2 tbsp flour
1/2 cup of skim milk powder (the original recipe calls for 1 cup milk, but boiled pumpkin has too much water, so the result is soggy if you don't use powder)

Mix together and pour into a prepared 9" pie tin. Bake at 400oF (200oC) for 10 minutes, then reduce the heat to 325oF (160oC) until a knife comes out clean.


This year we are expecting about 18-20 people for dinner tomorrow. It should be heaps of fun!

News for September and October

Baby Kangaroo (click for more pics)

  We are now on the Sunday of a three day holiday weekend.  Monday is Labour Day, it was moved from May to spread out the public holidays more evenly over the year.  Yesterday we were heading into town to go to the butcher.  We were looking for a turkey for our regular Thanksgiving party next weekend.  As we were crossing the bridge we saw some people rafting on the river and a gathering at part on River Street.  We decided to take a look.  While there we saw a booth for the wild animal rescue society.  They had baby kangaroos, wallabies and possums.  One of the local art galleries was also wrapped in knitting. After the park we did get to the butcher, and did get a turkey for Thanksgiving next weekend.

Eungella at night (more pics)

  A couple of weeks back we went camping at Eungella National Park.  We tried an experiment.  We put a queen sized air mattress in the back of my work van (a VW Caddy).  It worked quite well except that when we left Mackay it was 27 degrees C, but overnight it got down to 7C.  We did not pack enough blankets for such temperatures.  Nearly froze by morning. While there we did get a fleeting glimpse at a platypus, saw several turtles and of course, bush turkeys.  In the morning the clouds were below the height of the range, so we got to see a cloud covered Pioneer Valley and beautiful sunlit clouds.  (Pictures are here)

  

Training in Sydney

  This week I am down in Sydney for a week long training course.  I an being trained in the Konica Minolta C6000/C7000/C70hc.  These are the big production machines you seen in copy shops and printing companies.  The course is going quite well, but my brain is starting to get full.
  This is also Barb's first week back in Mackay after here six weeks in Bowen (about 3 hours drive north).  Starting next week we will actually get to live in the same town for 9 weeks in a row.  After that she is back up to Proserpine (1.75 hrs north).  Luckily next year she will be in Mackay for the whole year.

Canada Pictures are now up

Only 2 and a half weeks after returning, I've finally photos from our trip to Canada uploaded to the website.  They are now on the website.

This is a picture of Barb & I at Morraine Lake near Lake Louise in the Alberta Rockies.

Phil in Canda

  I've posted a few pictures of Phil the penguin on the website.  Phil is a stuffed penguin Barb got at Philip Island.  This is his most recent Canadian adventure.
  I am also working in the vacation photos from Canada and they should be up fairly soon.

Jack's Drive In

Today I had the chance to hit Jack's Drive In at Spruce Grove and have an ice cream. Oh, the memories! And the good ice cream! My family moved to Spruce Grove when I was 4 years old. Jack's had already been there and was known for it's fantastic ice cream, burgers, fried perogies (this is Ukrainian settled country) and now deep fried pickles?!??
Jack's was always a spot we'd always hit in summer months, walking, on bikes, in the car, or even running (our last day of gym class for my jr high days, we ran to Jack's from Woodhaven for ice cream, then ran back.)
Today I found out that they have now celebrated 50 years in the same place. Neat stuff, and uncommon these days. There was still a line up at the counter for ice cream- it's still going strong!

Proving Canadian grocery shopping can be as amusing as Australian

I had time to read a book...for FUN!

(Barb had previously posted this blog, but I accidentally deleted it. Here it is back again.  See backups are useful. -  Rob)

I had time to read a book...for FUN! Let me tell you about it!

I was captured by a snippet of a book (curse you, Amazon!)  and had to order it (via UK Book Depository, cuz they're cheaper). I have been reading "Emperor of All Maladies: A biography of Cancer" by Siddhartha Mukherjee.  It traces from the first record of cancer, in medical writings of Ancient Egypt. The entry describes a breast cancer, and it is short. For treatment it reads: "there is none". Crude surgery, prayers and poultices are attempted with dismal success for centuries afterwards.
Fast forward to the 20th century. Enter pioneers such as Halsted, the surgeon who invented the radical mastectomy, later Farber, Frei and Freilich who were the first to attempt using systemic chemotherapy. The began with leukemia, since there was no possible surgical approach possible to a cancer of the blood. The book traces through the 1950's and 60's, when the optimism of technological feats such as the Manhattan Project and moon landing made scientists and later the public dream of a Cure for cancer. And the distressing discoveries that cancer is not one enemy, but millions of types, grades and behaviours.  Then the innovations that allow us to tackle specific cancers as we do today, with molecular targets based on the exact cancer, where possible.
What blows me away repeatedly as I read this book is how very ridiculously young the medicine I am practicing is. Informed consent first entered medical vocabulary in the 1980's. The very concept that we can target one type of living thing and leave its host untouched was only dreamed up on a train one night in the 1880's. The practical consequence, antibiotics, only appeared in use in the 1930's. That's right, I have living grandparents who were born in a pre-antibiotic era. Think about that. Almost every one of us alive today has had a course of them to stave off some bug or another. in 1910, you had to wait and see if it would go away without killing you or leaving you with permanent disability. The first trial of cytotoxic chemotherapy was attempted in the 1940's. The participants had nothing left to lose, and unfortunately, all had died of relapse within the first year of remission. But there HAD been a remission- a slight waver in the natural trajectory of the monster.  Radiation therapy was born in the 1960's. Today, some cancers have a 95% cure rate. Not remission- CURE. That's incredible advancement in 50 years.
What does this tell me?
1. What's the best treatment today may not be next week. 60 years ago the best chance for breast cancer was removal of the breast, pectoral muscle, lymphnodes, and sometimes even the underlying ribs. It took years to find enough brave surgeons to attempt lumpectomies with radiotherapy to prove that the less involved surgery was not inferior. (That trial was finalized in the late 1980's). This reminds me to pay attention to my CMJ, MJA, Lancet and NEJM. It shows me the possibilities of what I may be telling my patients in the coming years. And even though I loathed Evidence Based Medicine lectures during med school, EBM should be the bottom line for current practice.

2. There is still a lot of hope. There are cancers such as melanoma, pancreatic and renal cell carcinomas that still have dismal prognoses if they cannot be resected entirely at an early stage. We have managed to find out an insane amount about previously untreatable entities in a matter of decades. Who knows what might break through next?

3. Clinical trials may or may not actually benefit the patient being treated, but the ones that follow him or her on the same dark path. That must give us pause to consider the ethics of the situation.

4. In the medical merry-go-round of tests, treatments and technology, never forget to care about the PERSON in front of you. If you care for someone long enough, there will be a point at which the tide can no longer be turned, and the goals of treatment need to be undressed to bare dignity and comfort. Never forget those goals should always be there.

Leaving winter behind

  Tomorrow we leave the Australian winter for the Canadian summer.  Mackay is forecast to be 19°/9°C while Spruce Grove is supposed to be 22°/10° when we arrive on Saturday.  This is the point in the year that Edmonton and Mackay are the pretty much the same temperature.  Mackay will cool down a bit in July and August, while the Canadian summer moves in to full swing.  The temperatures meet up again in September. 
  These toques and other winter apparel were at our local servo (service station) about 2 metres from a similar rack with thongs (flip flops).  Ah, Australia.

All the Vegemite

  Aussies do love their Vegemite as witnessed by the whole shelf of different sizes

Clermont trip

Wednesday & Thursday I was out west again.   This time was Moranbah & Clermont.  Since I wasn't going to make it back to Mackay until after 5pm, I decided to take my time coming back and shot some video and photographs.   Here is the video and I'll upload some photos later.

Blooming cane

  In the past couple weeks the local sugar cane has started blooming.  This is the first time in 3.5 years of living in Australia that I've seen blooming cane.  I did not know it bloomed until I saw it.  Although it makes sense that it would.  May to December is the usual cane harvesting times, so we should be seeing that start up fairly soon.  In many ways sugar cane looks like an over-sized field of brome grass.

Here is just a random rainbow picture I took today on the trip back from Proserpine.

Trip north for work

  Today was another trip away from Mackay. This time it is Arlie Beach and Cannonvale.
  I had a lovely lunch on the beach;  bacon and egg sandwich with a coke.

Chaos!

  Just finished work today in Moranbah.  It was one of those days when everything that could go wrong did.  It actually started last Friday.  The customer phoned in at 6 o'clock wanting their machines installed for Monday at 11am.  The machine wasn't ready, so I did the run-up Sunday afternoon.  Found out 8am this morning that it was to be me that was taking the two machines out west (2.5 hrs from Mackay).  Turns out the second machine wasn't ready either.  Dave had to spend more than an hour on it.  While he did that, I ran home to get a change of clothes and a toothbrush just in case I needed to stay overnight.
  Finally I left Mackay at about 10:20.  It turns out the customer thought I was supposed to be out there at 11:00. After all the delays for roadworks I arrived at 1:20, to find out the IT person I was told to expect wasn't there.  In fact, the local office didn't even know I was coming today.
  I continued onward by unloading both the machines.  Set them up on the network and contacted the company's IT.  They did their magic on the server. Turns out their magic wasn't working well.  Something on the server side wasn't working. Now the customer can't print because the new machines aren't set up and the old ones are disconnected.
  This all took until 5pm to sort out.  IT will continue to try tho solve the problem and I'm staying overnight in Moranbah. Tomorrow morning I will go back to do the training and finish off the last of the set up.  The saga continues.....

Mackay Motorshow 2013

I went to the Mackay Motorshow today.  Took some video of the cars and here it is.

A locavore's delight

Th best butcher shop in Mackay is Meat on Shakespeare.  Their smoked bacon is beyond amazing. But they also carry what some would consider exotic.  Not here! Kangaroo meat is good for the environment and lean and delicious.  It reminds me of bison meat in Alberta. Croc meat is difficult to cook well, as it dries out quickly, and flakes like fish. It definitely doesn't taste like chicken!

Eh-team.net is dead. Long live eh-team.net

  We are in the process of moving our website to an Australian hosting company.  The company here (Crazy Domains) has transferred our address from our old host to them, but to us.  Long story short, the domain name "eh-team.net" isn't accessible at either the old or new host until at least Monday.  The blog is still working, but that is a about it.
  We switched to an Australian server, because it was slow for us getting our e-mail, and the Aus host is cheaper.  The website might be a bit slower for those of you north of the equator (when it is back).

Out West

  Twice now, I've headed out west the Peak Downs Highway.  Both times have been for work.  The first time was all the way to Emerald to drop off a machine and pick up two more.  That trip involved a overnight stay in Emerald itself.  The last trip on 22 April, was to pick up a machine at one of the coal mines.  That time I was able to go there and back in a single day.  It was about 4 1/2 hour drive each way.  It's very lovely scenery out there and it makes for a lovely drive.  Driving a Volkswagen Transporter may not be the best vehicle to take, but it is okay.
  On the last trip I caught the tail end of a cattle muster using at least 3 horses and a helicopter.  Several times I had to pull over for wide loads.  When I say wide loads I mean WWIIIDDDEEE loads.  The truck take up both lanes and most of the shoulder.  You have to pull right off the raod to let them by.

Psychiatry is for Sadists

No- mental illness is NOT funny to experience, and I am in awe of the professionals who face up to the challenge of minimizing the damage it can do.  These are just some goofy pictures.
Let's start with paranoid delusions:

Hypochondria...

This is just cruel. The only was this could be meaner is if it was behind glass and could not me fixed.

Phobia- I'm afraid of what inspired this!

GAH!!!

 

I'm sure that's a popular therapy session!

Continuing fun with visas

As many of you may know, I (Rob) originally applied for a visa back in July of 2008.  There are have been many delays due to changes in immigration policy since then.  We have just received news from our immigration lawyer that the end may be in sight.  Apparently the immigration department is now working on applications from May of 2008.  That's right, it only 59 months to process an application!!  At this rate, I  should have a permanent residency visa in the next 2-3 months.  Unless immigration policy changes again :-(

Doc's place

Just down the street from the hospital is the nearest fast food joint. Doc's Place. As expected, it serves the kind of food that puts people in hospital, eventually. Fat, starch, sugar food groups are all represented here. But I can't get on too big of a soap box, as it is not owned or run by the hospital or QHealth. And I have now been here for lunch twice. They do make a lovely fresh roast beef sandwich too. Nothing gets me more frustrated than seeing a hospital cafeteria with deep fried everything. Currently our new cafe in hospital has lots of caffeine,  fresh sandwiches and salads for lunches and a small section of sausage rolls and meat pies (this IS Australia after all). I hope it stays that way.

 

Speaking of food that puts people in hospital, Wendy's in Canada has just put out a "Ultimate Canadian Combo"  which includes a Baconator, poutine and a medium Coke weighs more than a kilogram and contains a cool 1,860 calories, 3,380mg of sodium and thanks primarily to the "medium" Coca-Cola, 17 teaspoons of sugar. Lord have mercy. Good thing I'm taking Advanced Life Support Training over the next two days, because between the diabetes and artherosclerosis, you might need it if you pack this away with any regularity.

First block complete.

I have now been doctoring for 12 weeks, in General Medicine. That involves pretty much everything except legs and arms. OK, we did look after a few people with cellulitis on legs and arms. So Ok, mostly everything.... I have learned a lot. Filled in so much paperwork.  And enjoyed looking after my own patients. I had the privilege of applying my Palliative Care experience (So thankful that I took that as my elective last year!). We also saw most people get better and leave hospital. I can say I honestly love my job. Very grateful for the good team of nurses, wardies, Doctors and allied health that made it such a positive experience.

 

This is a lonely yet mysterious shrimp tail that lived on the 5th step of the flight of stairs between Gen Surg ward and Medical F2 ward. Apparently it was there a total of 15 weeks, and left this week. Why was it there? Where did it go? Why did it take so long to leave? Did it put up a fight? Will it ever return?  I will never know, as I am heading to Paediatrics, starting Monday morning. So many questions unanswered. 

 

Flu season struck Mackay Base Hospital early this year, with a number of deaths from Influenza A. For the love of peanut butter, GET YOUR FLU SHOT!!!  The above photo is Dr. Lee's approach to bird flu: Contain It! Picture taken at MBH ICU.